Understanding High BP

Dr. K. Shilpi Reddy

HOD & Sr. Consultant Obstetrician and Gynaecologist

KIMS Cuddles, Kondapur

It is the most common complication in Pregnancy. When you develop High BP first time in Pregnancy then it is called Gestational Hypertension or Pregnancy induced Hypertension. Gestational hypertension is defined by BP readings of ≥140/90 mmHg on 2 occasions at least 4 hours apart during pregnancy after 20 weeks’ gestation in a previously normotensive patient, without the presence of proteinuria (<300 mg in 24 hours) or other clinical features suggestive of of preeclampsia (thrombocytopenia, impaired renal or kidney function, pulmonary edema, or new-onset headache).

Types 

High blood pressure can present itself in a few different ways during pregnancy.
The following are the common types of gestational hypertension:

  • Chronic Hypertension– Women who have high blood pressure (over 130/90) before pregnancy, early in pregnancy (before 20 weeks), or continue to have it after delivery.
  • Gestational Hypertension– High blood pressure that develops after week 20 in pregnancy and goes away after delivery.
  • Preeclampsia – Both chronic hypertension and gestational hypertension can lead to this severe condition after week 20 of pregnancy. Symptoms include high blood pressure and protein in the urine. This can lead to serious complications for both mom and baby if not treated quickly.
  • Eclampsia – occurrence of one or more convulsions superimposed on pre-eclampsia.

Risk Factors

The following women may have an increased risk of developing gestational hypertension:

  • First-time moms
  • Women whose sisters and mothers had PIH
  • Women carrying multiples
  • Women younger than age 20 or older than age 40
  • Women who had high blood pressure or kidney disease prior to pregnancy

Symptoms

Watch for these symptoms. However, keep in mind that some of these symptoms are common among pregnant women and don’t necessarily mean you have a problem.

  • Constant headache.
  • Changes to your vision.
  • Abdominal pain.
  • Nausea and vomiting.
  • Shortness of breath.
  • Swelling of your hands and face.
  • Low, or no, urine.

Prevention

Women who are at high risk of pre-eclampsia are recommended to take 75 mg aspirin daily from 12 weeks of gestation to delivery[3]. Such women are those with:

  • Hypertension or pre-eclampsia/eclampsia in a past pregnancy.
  • Chronic kidney disease.
  • Autoimmune disease (eg, systemic lupus erythematosus (SLE) or antiphospholipid syndrome).
  • Diabetes mellitus (both type 1 or 2).
  • Chronic hypertension.

Complications

Women with hypertension in pregnancy have a higher risk of complications such as:

The fetus has an increased risk of:

Diognosis

Diagnosis is often based on the increase in blood pressure levels, but other symptoms may help establish PIH as the diagnosis. Tests for pregnancy-induced hypertension may include the following:

  • blood pressure measurement
  • urine testing
  • assessment of edema
  • frequent weight measurements
  • eye examination to check for retinal changes
  • liver and kidney function tests
  • blood clotting tests

.An ultrasound scan is required to check your baby’s growth, and use a Doppler Scan to measure the efficiency of blood flow to the placenta.

Treatment

Specific treatment for pregnancy-induced hypertension will be determined based on:

  • your pregnancy, overall health and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease

The goal of treatment is to prevent the condition from becoming worse and to prevent it from causing other complications. Treatment for pregnancy-induced hypertension (PIH) may include:

  • Bedrest (either at home or in the hospital may be recommended).
  • hospitalization (as specialized personnel and equipment may be necessary).
  • Anti-Hypertensive Medications- magnesium sulfate, Labetalol, calcium channel blockers , Diuretics, etc.
  • fetal monitoring (to check the health of the fetus) may include:
    • fetal movement counting – keeping track of fetal kicks and movements. A change in the number or frequency may mean the fetus is under stress.
    • nonstress testing – a test that measures the fetal heart rate in response to the fetus’ movements.
    • biophysical profile – a test that combines nonstress test with ultrasound to observe the fetus.
    • Doppler flow studies – type of ultrasound that uses sound waves to measure the flow of blood through a blood vessel.
  • continued laboratory testing of urine and blood (for changes that may signal worsening of PIH).
  • medications, called corticosteroids, that may help mature the lungs of the fetus (lung immaturity is a major problem of premature babies).
  • delivery of the baby (if treatments do not control PIH or if the fetus or mother is in danger). Cesarean delivery may be recommended, in some cases.

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